M
Mary Anne PA
PEYRONIE’S DISEASE: (By Dr. Stephen Adams Perth)
Peyronie’s Disease, (PD) has been a recognized condition for many years originally named after Napoleon’s surgeon. PD causes penile fibrosis which can appear spontaneously or triggered by minor penile trauma. The penile fibrosis occurs in “plaques” which form lumps or cords in the outer casing or “tunica” of the corpora cavernosum, (erectile tissue of the penis,) this leads to deformity of the erect penis either causing a bend often to more than a right angle, or an “hourglass” narrowing. Erectile dysfunction, (ED) is very common and there is therefore extreme difficulty achieving vaginal penetration. The condition can be painful and distressing.
PD was originally thought to be a rare condition but recent studies show a prevalence of 8-9% with 6-10% of cases occurring in men less than 40. The cause of PD in unknown and there is a history of penile trauma in less than 60%. Genetic studies suggest a hereditary predisposition to development of a proliferative fibrotic reaction to some sort of tissue insult or trigger. There is an association with other fibrotic conditions including Dupuytren’s and Paget’s disease but no evidence of an underlying infective cause. Unfortunately, despite original optimistic figures, only 3-13% of cases resolve with time. ED is present in 70-90% and can be difficult to treat.
There have been many treatments suggested over the years, but to date none has been proved to have a disease modifying effect. Surgery should be delayed as long as possible given the chance of spontaneous resolution and the postoperative problems that can occur. Non-surgical treatments that have been used include:
• Vitamin E is thought to confer some benefit perhaps because of its antioxidant properties. It has long been recommended by naturopaths for fibrotic conditions. It can be taken as an oral supplement, usually at a dose of 1000mg daily. Vit E cream can also be applied to the penis. There are no double blind, placebo-controlled trials proving its value.
• Colchicine is used in the prevention and treatment of gout. It has shown some promise in animal studies. Its usefulness is limited by its tendency to cause significant gastrointestinal effects, particularly diarrhoea.
• Steroid injections into the plaque are no longer recommended because of a lack of clear evidence of benefit and the consequent long term effect on penile tissues which future surgery more difficult and less effective.
• Verapamil can be used by intra-lesional injection, topical gel or local application with iontophoresis. There are reports of some improvement in up to 60% but once again, no placebo controlled studies have been undertaken. Topical application is expensive but certainly less effective; the gel can be used in a compounded formulation with vit E.
• Interferon again has been reported to show some benefit but again is expensive and can cause flu-like side-effects.
• Extracorporeal shock wave treatment shows inconsistent reports of benefit.
Surgical treatments include plication or scoring of the scarred tunica in an attempt to allow straightening of the penis, or full excision of the plaque. Unfortunately surgery can lead to further deformity and shortening of the penis and worsening of the associated ED. The only definitive treatment of PD is replacement of the erectile tissue by inserting penile implants. Even this surgery is difficult and strong implants are needed to overcome the penile curvature.
Peyronie’s Disease, (PD) has been a recognized condition for many years originally named after Napoleon’s surgeon. PD causes penile fibrosis which can appear spontaneously or triggered by minor penile trauma. The penile fibrosis occurs in “plaques” which form lumps or cords in the outer casing or “tunica” of the corpora cavernosum, (erectile tissue of the penis,) this leads to deformity of the erect penis either causing a bend often to more than a right angle, or an “hourglass” narrowing. Erectile dysfunction, (ED) is very common and there is therefore extreme difficulty achieving vaginal penetration. The condition can be painful and distressing.
PD was originally thought to be a rare condition but recent studies show a prevalence of 8-9% with 6-10% of cases occurring in men less than 40. The cause of PD in unknown and there is a history of penile trauma in less than 60%. Genetic studies suggest a hereditary predisposition to development of a proliferative fibrotic reaction to some sort of tissue insult or trigger. There is an association with other fibrotic conditions including Dupuytren’s and Paget’s disease but no evidence of an underlying infective cause. Unfortunately, despite original optimistic figures, only 3-13% of cases resolve with time. ED is present in 70-90% and can be difficult to treat.
There have been many treatments suggested over the years, but to date none has been proved to have a disease modifying effect. Surgery should be delayed as long as possible given the chance of spontaneous resolution and the postoperative problems that can occur. Non-surgical treatments that have been used include:
• Vitamin E is thought to confer some benefit perhaps because of its antioxidant properties. It has long been recommended by naturopaths for fibrotic conditions. It can be taken as an oral supplement, usually at a dose of 1000mg daily. Vit E cream can also be applied to the penis. There are no double blind, placebo-controlled trials proving its value.
• Colchicine is used in the prevention and treatment of gout. It has shown some promise in animal studies. Its usefulness is limited by its tendency to cause significant gastrointestinal effects, particularly diarrhoea.
• Steroid injections into the plaque are no longer recommended because of a lack of clear evidence of benefit and the consequent long term effect on penile tissues which future surgery more difficult and less effective.
• Verapamil can be used by intra-lesional injection, topical gel or local application with iontophoresis. There are reports of some improvement in up to 60% but once again, no placebo controlled studies have been undertaken. Topical application is expensive but certainly less effective; the gel can be used in a compounded formulation with vit E.
• Interferon again has been reported to show some benefit but again is expensive and can cause flu-like side-effects.
• Extracorporeal shock wave treatment shows inconsistent reports of benefit.
Surgical treatments include plication or scoring of the scarred tunica in an attempt to allow straightening of the penis, or full excision of the plaque. Unfortunately surgery can lead to further deformity and shortening of the penis and worsening of the associated ED. The only definitive treatment of PD is replacement of the erectile tissue by inserting penile implants. Even this surgery is difficult and strong implants are needed to overcome the penile curvature.
